Health care costs by state

In 2012 Massachusetts adopted the most recent in a series of comprehensive legislative approaches to health care reform, Chapter 224 of the Acts of 2012 (Chapter 224), which focused especially on addressing the drivers of health care costs in the Commonwealth. A key element of this legislation was creation of the Health Policy Commission (HPC), to which Chapter 224 gave a broad portfolio of responsibilities, including reviewing material changes in corporate and clinical affiliations, registering provider organizations, certifying (non-CMS) accountable care organizations (ACOs) and patient-centered medical homes (PCMHs), and promoting alternative payment methods (APMs) and innovations in health care delivery.In implementing its responsibilities, Chapter 224 charged the HPC with conducting annual health care cost growth hearings and the preparation of an annual report based on those hearings; and with monitoring a benchmark of aggregate health care cost growth in Massachusetts that … [Read more...] about Thirteen Ways to Contain Health Care Costs in Massachusetts: Health Policy Commission Issues 2015 Report and Recommendations

Massachusetts continues to be at the national forefront of health care reform. Since becoming the first state in the nation to expand access aimed at universal health care coverage through Chapter 58 of the Acts of 2006, Massachusetts has continued to address legislative and regulatory challenges in the health care industry. The current legislative session’s policy focus has been health care payment reform, and the Massachusetts Senate, House of Representatives and governor have each proposed their own unique approach to transition the market away from fee-for-service and to contain cost growth.The Senate BillOn May 9, 2012, the Massachusetts Senate released Senate Bill 2260, “An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation.” The bill proposes to reduce state health care costs over the next 15 years by $150 billion.Highlights of the Senate Billestablishes a quasi-public authority that assists in … [Read more...] about Massachusetts Releases Health Care Cost Containment Legislation

Earlier this week, the Kaiser Family Foundation and the Altarum Institute’s Center for Sustainable Health Spending published an analysis of the recent slowdown in health care spending. The study asserts that macroeconomic conditions are the most important factor in determining systematic health care costs. The analysis concludes that the modest increases in health care spending over the last several years will likely be replaced with higher, more “normal” rates of growth as economic conditions improve. Greater increases in health spending will in turn lead to continued pressure to contain costs. Since the ACA’s enactment, health care costs have increased at a much reduced rate as compared to the previous several decades. According to CMS , in 2011 health spending in the U.S. grew 3.9% and was 17.9% of GDP (the same proportion of GDP as in 2009 and 2010). The rate of growth for … [Read more...] about Despite the Affordable Care Act’s (ACA) Cost-Saving Measures, Modest Increases in Health Care Costs Unlikely to Continue

The Massachusetts House overwhelmingly approved its version of legislation designed to cut the cost of medical care, passing the measure 148-7 after a full day of debate on June 5th. After it initially released a bill on May 4th (see our prior alert), House leadership, including the original author, Representative Steven Walsh, accepted feedback and recommendations from various stakeholders. A minimally revised bill emerged from the House Ways & Means Committee on May 30th and House legislators then offered 275 amendments to that updated version.One noteworthy provision included in the House Ways & Means Committee redraft bill would double the number of patients who can join an accountable care organization to 800,000, a change that would provide some relief for large networks. The redraft also places the independent authority that would set guidelines and monitor compliance envisioned in the original legislation under the Executive Office of Health and Human Services. House … [Read more...] about MA House Passes Health Care Cost Containment Bill

Leading the NewsSenate HELP Updates Track-and-Trace, Compounding ProposalsOn July 24th, the Senate Health, Education, Labor, and Pensions (HELP) Committee released updates to its drug compounding and track and trace legislation. Committee Chairman Tom Harkin (D-IA) and Ranking Member Lamar Alexander (R-TN) say they hope the Senate will pass the measure by unanimous consent in the near future. On July 25th, the Congressional Budget Office (CBO)indicated the bill would have virtually no impact on the federal budget. House Energy and Commerce Subcommittee Advances SGR BillOn July 24th, the House Energy and Commerce Subcommittee on Health passed by voice vote a bill to repeal the sustainable growth rate (SGR) Medicare physician payment method. The bill now moves to the full committee, which will consider a repeal of the SGR on July 31st. Rep. Michael Burgess (R-TX) suggested the committee will support the bill, but he said the legislation could become part of … [Read more...] about Health Care Reform Update – July 29, 2013

Leading the NewsSCOTUS Historic DOMA Ruling Health Insurance ImplicationsOn June 26th, Supreme Court Justice Anthony Kennedy wrote in his majority opinion addressing the Defense of Marriage Act (DOMA) that the legislation inappropriately raises insurance costs for same-sex couples. The court struck down DOMA by a 5-4 vote. Just two days later, the U.S. Office of Personnel Management indicated it will allow same-sex spouses of federal employees to begin applying for health insurance benefits.CMS Releases Final Minimum Essential Coverage RuleOn June 26th, the Department of Health and Human Services (HHS) issued a final rule on exemption eligibility and miscellaneous minimum essential coverage provisions within the ACA exchanges. The rule notes that individuals who live in states where Medicaid coverage is not expanded will not need to pay a penalty if they fail to obtain insurance coverage.Implementation of the Affordable Care ActOn June 25th, the Brookings … [Read more...] about Health Care Reform Update – Week of July 1, 2013

Leading the NewsHouse Passes CR Funding the Government, Defunding ACAOn September 20, the House of Representatives passed a continuing resolution (CR) funding the government until December 15thand defunding the Affordable Care Act (ACA). The bill now moves to the Senate, where Majority Leader Harry Reid (D-NV) has said that Democrats will use a simple majority vote to strip out the provision defunding the ACA. Following House passage of its CR, Senator Reid and Senator Max Baucus (D-MT) released a letter from Secretary Sebelius, in which she responded to their concerns about the effect of the Republican CR on Medicare, Medicaid, and Children’s Health Insurance Plan beneficiaries. In the letter, Secretary Sebelius stated that the CR would have disastrous effects by removing necessary reforms, disrupting payments, and potentially requiring beneficiaries to pay thousands of dollars out-of-pocket for care.CMS Proposes Basic Health Program RuleOn September 20, … [Read more...] about Health Care Reform Update – September 23, 2013

On August 18, 2014 the Department of Justice (DOJ) announced that Carondelet Health Network (CHN), has agreed to pay $35 million to settle allegations that its affiliate hospitals, Carondelet St. Mary’s and Carondelet St. Joseph’s in Tucson, Arizona, knowingly violated the False Claims Act by overcharging the U.S. Government when it submitted false bills to Medicare and other Federal Health Care programs. DOJ also announced that the whistleblower, Jacqueline Bloink, formerly employed by the CHN, is entitled to a share of the settlement payment for reporting fraud against the government, which amounts to $6 million.Ms. Bloink originally filed the lawsuit under the whistleblowers provisions of the False Claims Act, which is one of the most effective methods that the government has implemented for combating fraud. Under the FCA, any person, who knows of an individual or company that has financially defrauded the federal government, can file a "qui … [Read more...] about Carondelet Health Network To Pay $35 million To Settle Federal Health Care Billing Fraud Case; Whistleblower To Receive $6 million

The Federal Trade Commission’s (“FTC”) recently submitted Congressional Budget Justification and Annual Performance Plan and Report contains helpful insight into the FTC’s focus and expectations for the coming fiscal year. Of particular note, is a slight shift of funds from activities designed to “protect consumers” to activities intended to “promote competition.” High on the FTC’s list of actions designed to promote competition is continued scrutiny of the health care industry. And to that end, the FTC reiterated its intention to, among other things:Take action against anticompetitive agreements among health care providers and to challenge anticompetitive mergers of hospitals, medical device manufacturers, pharmaceutical companies, and other health care providers that contribute to the rising cost of health care. The FTC will also continue to advance its health care enforcement program by challenging … [Read more...] about FTC’s 2018 Congressional Budget: Continued Focus on Health Care Industry

On February 24-25, 2015, the Federal Trade Commission (“FTC”) and Antitrust Division of the Department of Justice (“DOJ”) co-hosted a second public workshop as part of the “Examining Health Care Competition” series to study recent developments related to provider organization and payment models affecting competition in the health care sector. The workshop explored five key themes: (1) provider network design, contracting practices, and regulatory activity; (2) early observations regarding health insurance exchanges; (3) early observations regarding accountable care organizations (“ACOs”); (4) alternatives to traditional fee-for-service payment models; and (5) trends in provider consolidation. Opening Remarks Emphasize Enforcement Stance of AgenciesOpening remarks on the first day of the workshop were provided by FTC Chairwoman Edith Ramirez, who reiterated that health care remains one of the FTC’s top priorities and that the … [Read more...] about Federal Trade Commission and Department of Justice Hold Joint Workshop on Payment Models and Competition Within the Health Care Sector